Losing 250+ strands per day, GP thinks I'm crazy, and dermatologist's diagnosis doesn't make sense. I don't know what to do. I'm desperate and at the end of my rope. This is a very long post but please help me

Hi all.

I'm a trans woman, 26 years, old, who's had an orchiectomy - an outpatient surgery that prevents my body from producing significant amounts of testosterone - in March of 2020. In november of 2021, I learned that my doctor had had me on a very low dose of estrogen for a year (from nov. 2020 to nov. 2021), such that I'd be considered at post-menopausal levels, but my dose was doubled 3 months ago. She also put me on Finasteride 3 months ago, and I've been using minoxidil 5% for two weeks.

I first noticed my hair loss in about July of 2021. It didn't seem like it was focused in any particular area, and still doesn't. My partner convinced me I was fine. It gradually got worse, so I went to see my endocrinologist in November. That's when the hormonal imbalance was discovered and corrected. I also started 2.5 mg daily finasteride then.

By January, it was getting worse, and I managed to get an appointment with a dermatologist. She looked at my scalp and told me I had new growth along the hairline, but thinning on the top of the hairline, and told me I was probably recovering, but told me to use minoxidil 5% if I noticed symptoms continuing. She diagnosed me with telogen effluvium, which she said is a type of hair loss that is caused by stress or trauma, and said it can unmask existing hormonal hair loss. I can see why I'd have hormonal hair loss, given what I went through, but I can think of no causes of TE. Sure, i have been stressed, but I have had FAR, FAR more stressful times in my life during which my hair was fine. Also, I understand how my past hair loss could have been hormonal, but I don't see how it could still be going even when my levels are more normal.

Two weeks ago, I began to be able to see my scalp under my hair when it was dry. I started minoxidil then (yes I know it's too early to get results) and got another appointment with my dermatologist. I went to see her, crying, and she just seemed annoyed. I asked for her to look at my scalp and tell me whether or not it fit male/female patterns of hair loss which she didn't do. I asked her to further explain her diagnosis, explaining my confusion, which she didn't do. I asked her to order blood tests to see if it's due to a nutrient deficiency which she didn't do. She scolded me for coming back too soon, very patronizingly told me it was too early to tell if the rogaine was working, and forbade me from seeing her any earlier than August even if my hair loss got much much worse. I left the appointment dejected, but called back and demanded at the very least some blood tests. She ordered a blood iron test and a thyroid stimulating hormone test.

I saw my GP to see if there was anything she could do for me. She ordered collective blood count, metabolic panel, estradiol and testosterone tests. She also looked at my scalp, told me I had thick hair, that it was normal to lose up to 100 strands, andbsuggested I try to count how many hairs I was losing. She said she sees no evidence of loss, and suggested I look into testing for obsessive-compulsive disorder, which she told me often manifests related to hair.

My blood test results came back today. My CBC, metabolic, thyroid, and iron tests all came back normal. My estrogen came back at what my endocrinologist told me is a good level for a trans woman (234 pg/ml), and my testosterone is lower than that of the average cis woman's. My doctor is doubling down on OCD because of my normal blood tests. I had a complete psychiatric evaluation done in December of 2020 which showed no tendencies toward obsessive or compulsive behavior, so while I understand her perspective, I am skeptical. Finally, I went through the strands I shed during my shower today to see about how many I was losing, and ended up with more than 250, of all lengths.

I am at the end of my rope. My doctor doesn't believe me, my dermatologist's diagnosis makes no sense, and the only plausible cause of my hair loss (hormonal issues) has been corrected for 3 months, yet I'm seeing huge losses of hair still. I have nowhere to turn. There are no hair specialists anywhere within 200 miles of me, no other dermatologists will see me at my clinic system, and I'm on medicaid which severely limits my ability to see new doctors.

Ultimately, here's my confusion:

• If it's hormonal hair loss, why is it getting worse 3 months after I corrected my hormone levels?

• If it's androgenic alopecia, how can that be happening when my testosterone levels are ridiculously low and while I'm on finasteride, a medication that's supposed to stop it?

• If it's telogen effluvium, how could that be possible without any traumatic event to trigger it.

If anyone has read this far, what else could it possibly be? What else can I do?

Hi all.I'm a trans woman, 26 years, old, who's had an orchiectomy - an outpatient surgery that prevents my body from producing significant amounts of testosterone - in March of 2020. In november of 2021, I learned that my doctor had had me on a very low dose of estrogen for a year (from nov. 2020 to nov. 2021), such that I'd be considered at post-menopausal levels, but my dose was doubled 3 months ago. She also put me on Finasteride 3 months ago, and I've been using minoxidil 5% for two weeks.I first noticed my hair loss in about July of 2021. It didn't seem like it was focused in any particular area, and still doesn't. My partner convinced me I was fine. It gradually got worse, so I went to see my endocrinologist in November. That's when the hormonal imbalance was discovered and corrected. I also started 2.5 mg daily finasteride then.By January, it was getting worse, and I managed to get an appointment with a dermatologist. She looked at my scalp and told me I had new growth along the hairline, but thinning on the top of the hairline, and told me I was probably recovering, but told me to use minoxidil 5% if I noticed symptoms continuing. She diagnosed me with telogen effluvium, which she said is a type of hair loss that is caused by stress or trauma, and said it can unmask existing hormonal hair loss. I can see why I'd have hormonal hair loss, given what I went through, but I can think of no causes of TE. Sure, i have been stressed, but I have had FAR, FAR more stressful times in my life during which my hair was fine. Also, I understand how my past hair loss could have been hormonal, but I don't see how it could still be going even when my levels are more normal.Two weeks ago, I began to be able to see my scalp under my hair when it was dry. I started minoxidil then (yes I know it's too early to get results) and got another appointment with my dermatologist. I went to see her, crying, and she just seemed annoyed. I asked for her to look at my scalp and tell me whether or not it fit male/female patterns of hair loss which she didn't do. I asked her to further explain her diagnosis, explaining my confusion, which she didn't do. I asked her to order blood tests to see if it's due to a nutrient deficiency which she didn't do. She scolded me for coming back too soon, very patronizingly told me it was too early to tell if the rogaine was working, and forbade me from seeing her any earlier than August even if my hair loss got much much worse. I left the appointment dejected, but called back and demanded at the very least some blood tests. She ordered a blood iron test and a thyroid stimulating hormone test.I saw my GP to see if there was anything she could do for me. She ordered collective blood count, metabolic panel, estradiol and testosterone tests. She also looked at my scalp, told me I had thick hair, that it was normal to lose up to 100 strands, andbsuggested I try to count how many hairs I was losing. She said she sees no evidence of loss, and suggested I look into testing for obsessive-compulsive disorder, which she told me often manifests related to hair.My blood test results came back today. My CBC, metabolic, thyroid, and iron tests all came back normal. My estrogen came back at what my endocrinologist told me is a good level for a trans woman (234 pg/ml), and my testosterone is lower than that of the average cis woman's. My doctor is doubling down on OCD because of my normal blood tests. I had a complete psychiatric evaluation done in December of 2020 which showed no tendencies toward obsessive or compulsive behavior, so while I understand her perspective, I am skeptical. Finally, I went through the strands I shed during my shower today to see about how many I was losing, and ended up with more than 250, of all lengths.I am at the end of my rope. My doctor doesn't believe me, my dermatologist's diagnosis makes no sense, and the only plausible cause of my hair loss (hormonal issues) has been corrected for 3 months, yet I'm seeing huge losses of hair still. I have nowhere to turn. There are no hair specialists anywhere within 200 miles of me, no other dermatologists will see me at my clinic system, and I'm on medicaid which severely limits my ability to see new doctors.Ultimately, here's my confusion:If it's hormonal hair loss, why is it getting worse 3 months after I corrected my hormone levels?If it's androgenic alopecia, how can that be happening when my testosterone levels are ridiculously low and while I'm on finasteride, a medication that's supposed to stop it?If it's telogen effluvium, how could that be possible without any traumatic event to trigger it.If anyone has read this far, what else could it possibly be? What else can I do? https://ift.tt/kAGLQts https://ift.tt/4QYwno1